2027 Advanced Faculty Leadership Academy

2027 Advanced Faculty Leadership Academy

Have you previously attended a leadership course?
If yes, please select:
Please specify other:
Applicant Information
First: Middle Initial: Last:
E-mail:
Gender
     Self-Identify Gender:
Ethnicity
Race (Please select all that apply)
       
       
Office Information
Work Street Address:
Building:
Room:
City: State: Zip:
Campus phone: -
Cell phone: -
Select highest degree.
Please specify other:
Select primary academic classification.
Current Position and Titles
Title 1:
Title 2:
Title 3:
School:
Department:
Division:
Center/Institute:
Dean:
Nominated by
(Must be nominated by Department Chair, Division Chief, Center/Institute Director, or Dean)
First: Middle Initial: Last:
Title:
School:
Department:
Division:
Center/Institute:
Please indicate faculty rank.
Please specify other:
Are you currently in a leadership capacity?
If yes, please indicate title:
If you are an investigator, are you currently the principal person responsible for managing your laboratory or research program?
How many people are you responsible for supervising in your laboratory or research environment?

Postdoctoral Trainees:

Graduate & Undergraduate Students:

Research Staff:

If you are an educator, how many years have you been teaching?
What do you hope to accomplish by enrolling in this program? Please note that the thoughtfulness of your response will be a key factor in determining your acceptance into the program. (Limit 200 words)
Personal Commitment

I commit to attending the first session and will strive to attend all subsequent sessions, understanding that I am allowed to miss up to two sessions due to unforeseen circumstances while still working towards receiving my Certificate of Completion.

Please attach your letter of nomination. Sponsors should indicate how the applicant will be paying for the course, e.g., departmental funds, professional development fund, or personal funds. Nomination letters should be addressed to Faculty Leadership Academy Admissions Committee, University of Pittsburgh, M200AA Scaife Hall, Pittsburgh, PA 15261.
Please upload .PDF, .DOC or .DOCX only (4MB limit).
Please upload .PDF, .DOC or .DOCX only (4MB limit).